Healthcare Provider Details

I. General information

NPI: 1043912181
Provider Name (Legal Business Name): SOLA COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 BRISTOL AVE NW
GRAND RAPIDS MI
49504-4927
US

IV. Provider business mailing address

327 BRISTOL AVE NW
GRAND RAPIDS MI
49504-4927
US

V. Phone/Fax

Practice location:
  • Phone: 616-485-5920
  • Fax:
Mailing address:
  • Phone: 616-485-5920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANDREA LEE DIELEMAN
Title or Position: OWNER, THERAPIST
Credential: LMSW
Phone: 616-485-5920